The impact of the affordable care act (ACA) medicaid expansion on visit rates for diabetes in safety net health centers

Nathalie Huguet, Rachel Springer, Miguel Marino, Heather Angier, Megan Hoopes, Heather Holderness, Jennifer E. DeVoe

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: To (1) compare clinic-level uninsured, Medicaid-insured, and privately insured visit rates within and between expansion and nonexpansion states before and after the Affordable Care Act (ACA) Medicaid expansion among the 3 cohorts of patient populations; and (2) assess whether there was a change in clinic-level overall, primary care visits, preventive care visits, and diabetes screening rates in expansion versus nonexpansion states from pre-ACA to post-ACA Medicaid expansion. Methods: Electronic health record data on nonpregnant patients aged 19 to 64 years, with >1 ambulatory visit between 01/01/2012 and 12/31/2015 (n 483,912 in expansion states; n 388,466 in nonexpansion states) from 198 primary care community health centers were analyzed. Using a difference-in-difference methodology, we assessed changes in visit rates pre-ACA versus post-ACA among a cohort of patients with diabetes, prediabetes, and no diabetes. Results: Rates of uninsured visits decreased for all cohorts in expansion and nonexpansion states. For all cohorts, Medicaid-insured visit rates increased significantly more in expansion compared with nonexpansion states, especially among prediabetic patients ( 71%). In nonexpansion states, privately insured visit rates more than tripled for the prediabetes cohort and doubled for the diabetes and no diabetes cohorts. Rates for glycosylated hemoglobin screenings increased in all groups, with the largest changes among no diabetes (rate ratio, 2.26; 95% CI, 1.97-2.56) and prediabetes cohorts (rate ratio, 2.00; 95% CI, 1.80-2.19) in expansion states. Conclusion: The ACA reduced uninsurance and increased access to preventive care for vulnerable patients, especially those with prediabetes. These findings are important to consider when making decisions regarding altering the ACA. (J Am Board Fam Med 2018;31:905-916.).

Original languageEnglish (US)
Pages (from-to)905-916
Number of pages12
JournalJournal of the American Board of Family Medicine
Issue number6
StatePublished - Nov 1 2018


  • Cohort studies
  • Community health centers
  • Diabetes mellitus
  • Hemoglobins
  • Medicaid
  • Medically uninsured
  • Prediabetic state
  • Primary health care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


Dive into the research topics of 'The impact of the affordable care act (ACA) medicaid expansion on visit rates for diabetes in safety net health centers'. Together they form a unique fingerprint.

Cite this